Endoscopic sentinel lymph node biopsy using indocyanine green-neomannosyl human serum albumin.

Abstract

OBJECTIVE:

The aim of this study was to determine the possibility of endoscopic sentinel lymph node biopsy of the head and neck region using indocyanine green-neomannosyl human serum albumin (ICG:MSA) and a custom-made intraoperative color-and-fluorescence-merged imaging system (ICFIS).

METHODS:

Using mouse and rabbit models of tongue cancer, we performed sentinel lymph node biopsy using an ICG:MSA tracer and custom imaging system equipped with an endoscope.

RESULTS:

ICG:MSA was localized to the cervical lymph node on the ipsilateral side for up to 30 minutes compared to ICG tracer (ICG n = 3, IGC:MSA n = 3). Detection of sentinel lymph nodes was attempted after injecting ICG:MSA in the mouse tongue cancer model (n = 3). During the operation, lymph nodes were easily identified and resected using ICFIS without the aid of other magnifiers. In the rabbit tongue cancer model (n = 3), the ICFIS equipped with 30-degree endoscopy was used to confirm the feasibility of endoscopic sentinel lymph node biopsy. The entire sentinel lymph node biopsy procedure was performed using the ICFIS with the 30-degree endoscope. We detected and dissected sentinel lymph nodes in the rabbit model without the other sentinel lymph node detection tools.

CONCLUSION:

We confirmed the usefulness of sentinel lymph node biopsy using a near infrared fluorescence technique and endoscopic system. Avoidance of radiation exposure and shine-through phenomena, which are problems of sentinel lymph node biopsy using conventional radioisotopes, are advantages of our surgical technique. By combining the endoscopic system with a sentinel lymph node biopsy procedure, we avoided visible neck scars, which lead to excellent cosmetic outcomes.

LEVEL OF EVIDENCE:

NA. Laryngoscope, 128:E135-E140, 2018.

• Authors: Young Min Park, Yu Hua Quan, Ki Hyeok Kwon, Jae-Gu Cho, Jeong-Soo Woo, Beop-Min Kim, Yun-Sang Lee, Jae Min Jeong, Hyun Koo Kim, Jae-Jun Song
• Journal: The Laryngoscope (Laryngoscope) Vol. 128 Issue 4 Pg. E135-E140 (04 2018) ISSN: 1531-4995 [Electronic] United States
• PMID: 29214646 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Chemical References

• Coloring Agents
• Indocyanine Green
• Serum Albumin, Human

Topics

• Animals
• Coloring Agents
• Disease Models, Animal
• Endoscopy (methods)
• Feasibility Studies
• Indocyanine Green
• Infrared Rays
• Mice
• Neck Dissection (methods)
• Optical Imaging (methods)
• Rabbits
• Sentinel Lymph Node (diagnostic imaging, surgery)
• Sentinel Lymph Node Biopsy (methods)
• Serum Albumin, Human
• Tongue Neoplasms (surgery)